Basic critical care echocardiography: How many studies equate to competence? A pilot study using high fidelity echocardiography simulation

Background Assessment of competence in basic critical care echocardiography is complex. Competence relies on not only imaging accuracy but also interpretation and appropriate management decisions. The experience to achieve these skills, real-time, is likely more than required for imaging accuracy alone. We aimed to assess the feasibility of using simulation to assess number of studies required to attain competence in basic critical care echocardiography. Methods This is a prospective pilot study recruiting trainees at various degrees of experience in basic critical care echocardiography using experts as reference standard. We used high fidelity simulation to assess speed and accuracy using total time taken, total position difference and total angle difference across the basic acoustic windows. Interpretation and clinical application skills were assessed using a clinical scenario. ‘Cut-off’ values for number of studies required for competence were estimated. Results Twenty-seven trainees and eight experts were included. The subcostal view was achieved quickest by trainees (median 23 s, IQR 19–37). Eighty-seven percent of trainees did not achieve accuracy across all views; 81% achieved accuracy with the parasternal long axis and the least accurate was the parasternal short axis (44% of trainees). Fewer studies were required to be considered competent with imaging acquisition compared with competence in correct interpretation and integration (15 vs. 40 vs. 50, respectively). Discussion The use of echocardiography simulation to determine competence in basic critical care echocardiography is feasible. Competence in image acquisition appears to be achieved with less experience than correct interpretation and correct management decisions. Further studies are required.

KARATERISTIK DAN MEKANISME PERDAGANGAN CONTRACT FOR DIFFERENCE (CFD) SEBAGAI ALTERNATIF INVESTASI KEUANGAN (Studi Kasus Pada Pasar Derivatif di Australia)

The paper exploresthe nature of CFDs as a derivative and CFDs as hedging instrumentin derivatif markets in Australia. It argues that CFDis leveraged instrument, which means they offer the potential to make a higher return from a smaller initial investment relative to the total position value. Using CFD, we can obtain full exposure to a share or commodity for a fraction of the price of buying the underlying asset. The higher percentage return from the CFD demonstrates how leverage can work. The writer presents two parts in describing CFD’s nature and trading mechanism which are:the nature of the CFDs, which include CFDs’ characteristics and how they are traded. This part will focus on equity CFDs which underlying instrument is stocks. The second part will be an application of delta neutral hedging of long stock position by using and option compare to CFDs. Keywords: derivatif instrument, CFD, underlying asset, hedging, long position, short position

Research and Development in the Field of Passive Components

This paper firstly examines the market situation in passive components in relation to the total position of the electronics industry. Expenditure on research and development is then discussed and examples given of recent and present research and development activities in the field of passive components. The situation with regard to the publication position on research and development in passive components is briefly considered and it is concluded that there is a positive need for a journal covering the passive component field and acting as an outlet for papers generated in this area.